Reduction of pulmonary migration of permanent interstitial sources in patients undergoing prostate brachytherapy
Reduction of pulmonary migration of permanent interstitial sources in patients undergoing prostate brachytherapy
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DOI：
10.1016/j.urology.2005.01.047
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发表时间：
2005-07-01
期刊：
影响因子：
2.1
通讯作者：
Stock, RG
中科院分区：
文献类型：
--
作者：
Stone, NN;Stock, RG
目标.探讨一种减少永久性前列腺近距离放射治疗后粒子迁移问题的方法。永久性前列腺近距离放射治疗可以通过多种技术使用几种不同的种子配置来执行。所有这些都与一定程度的肺种子迁移有关，没有研究明确研究减少这一问题的方法。共有238例患者接受了碘-125（I-125; 146例患者）或钯-103（92例患者）植入。植入是在真实的时间使用一个施加器，与源放置在前列腺包膜下面。在1个月时进行植入后剂量测定。植入后至少4个月进行常规胸部X线检查; 24例患者进行了第二次胸部X线检查。共植入21，654粒粒子（中位数89，范围27 - 220）。在中位912天（范围147 - 3023天）时获得植入后胸部X线片，4例患者（1.7%）至少出现一个肺种子栓塞。在21，654粒种子中，在肺中发现10粒（0.005%）。所有4例患者均接受了I-125植入，导致I-125的肺栓塞率为2.7%（4/146），钯-103的肺栓塞率为0%（0/92）。如果在初始胶片上未观察到粒子移位，则没有患者发生后续粒子移位。接受I-125植入的所有患者的前列腺体积90%的中位剂量为172戈伊，4例粒子移位患者的中位剂量为174 Gy。当患者使用实时方法进行植入时，肺部种子栓塞是罕见事件。虽然在我们的系列中，I-125的迁移略大于钯-103，但未观察到对植入后剂量测定结果的负面影响。
Objectives. To investigate a method to decrease the problem of seed migration after permanent prostate brachytherapy. Permanent prostate brachytherapy can be performed by a number of techniques using several different seed configurations. All have been associated with some degree of pulmonary seed migration, and no studies have clearly investigated a means of decreasing this problem.Methods. A total of 238 patients underwent implantation with either iodine-125 (I-125; 146 patients) or palladium-103 (92 patients). The implant was performed in real time using an applicator, with the sources placed just underneath the prostatic capsule. Postimplant dosimetry was performed at 1 month. Routine chest x-ray was obtained a minimum of 4 months after implantation; 24 patients had a second chest x-ray taken.Results. A total of 21,654 seeds were implanted (median 89, range 27 to 220). Postimplant chest x-rays were obtained at a median of 912 days (range 147 to 3023), and 4 patients (1.7%) experienced at least one seed embolus to the lung. Of the 21,654 seeds, 10 (0.005%) were found in the lungs. All 4 patients had received an I-125 implant, resulting in a pulmonary embolus rate for I-125 of 2.7% (4 of 146) and for palladium-103 of 0% (0 of 92). No patients experienced subsequent seed migration if it was not seen on the initial film. The median dose delivered to 90% of the prostate volume for all patients undergoing I-125 implantation was 172 Gy and for the 4 patients with seed migration it was 174 Gy.Conclusions. Seed embolism to the lungs is a rare event when patients undergo implantation using the real-time method. Although in our series migration was slightly greater with I-125 than with palladium-103, no negative effect was seen on the postimplant dosimetry results.